Metabolic risk-factor clustering estimation in children: to draw a line across pediatric metabolic syndrome

Abstract

Background: The diagnostic criteria of the metabolic syndrome (MS) have been applied in studies of obese adults to estimate the metabolic risk-associated with obesity, even though no general consensus exists concerning its definition and clinical value. We reviewed the current literature on the MS, focusing on those studies that used the MS diagnostic criteria to analyze children, and we observed extreme heterogeneity for the sets of variables and cutoff values chosen. Objectives: To discuss concerns regarding the use of the existing definition of the MS (as defined in adults) in children and adolescents, analyzing the scientific evidence needed to detect a clustering of cardiovascular risk-factors. Finally, we propose a new methodological approach for estimating metabolic risk-factor clustering in children and adolescents. Results: Major concerns were the lack of information on the background derived from a child's family and personal history; the lack of consensus on insulin levels, lipid parameters, markers of inflammation or steato-hepatitis; the lack of an additive relevant effect of the MS definition to obesity per se. We propose the adoption of 10 evidence-based items from which to quantify metabolic risk-factor clustering, collected in a multilevel Metabolic Individual Risk-factor And CLustering Estimation (MIRACLE) approach, and thus avoiding the use of the current MS term in children. Conclusion: Pediatricians should consider a novel and specific approach to assessing children/adolescents and should not simply derive or adapt definitions from adults. Evaluation of insulin and lipid levels should be included only when specific references for the relation of age, gender, pubertal status and ethnic origin to health risk become available. This new approach could be useful for improving the overall quality of patient evaluation and for optimizing the use of the limited resources available facing to the obesity epidemic.

Abdominal obesity and cardiometabolic risk in children and adolescents, are we aware of their relevance?

“…However, considering children and adolescents, some studies have proposed scientific evidence's items to evaluate and characterize this population with metabolic risk factors, since there is not an updated and precise definition. These items include personal and family history, pubertal status, metabolic abnormalities, and clinical feature [125,126].…”

Progress and Challenges in Metabolic Syndrome in Children and Adolescents

“…267 A recent review of these attempts to provide a definition in children highlighted the limitations of deriving or adapting definitions from adults and advocated for consideration of a novel and specific approach for children. 268 Specific concerns related to the conceptualization of the MetS include an incomplete understanding of the underlying pathophysiology and considerable variation regarding its manifestation related to age, sex, ethnicity, and maturation. Given the lack of hard clinical end points in the pediatric setting, the relationship between the individual risk factors and their clustering on the atherosclerosis disease process is difficult to define.…”

Influencia del sexo y el tipo de escuela sobre los índices de sobrepeso y obesidad

“…10 Overweight also promotes the development of metabolic syndrome, 11 defined as a cluster of risk factors for cardiovascular disease, including high blood pressure. 12 Different studies point at sedentary behaviours, 13 lack of physical activity, especially vigorous activity, 15 and contemporary dietary habits 16 as the main causes of excess fat accumulation.…”